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Wednesday, November 7, 2012

A GROUP OF DOCTORS WANT TO DECIDE FOR ALL PAIN PATIENTS

"I could imagine the cocaine high. I hadn't touched the stuff for 6 months but I had never stopped craving it."
He took the cocaine, liquid on his tongue. "(His) anxiety melted away. (His) level of alertness rose." (from PROJECTION by Keith Ablow)

"I had to take codeine for the pain. My mouth is dry, my head feels fuzzy, and I just hate this feeling the drug gives me but I have to take it."
"I was on up to 14 grains a day for 12 years and the day after the pain stopped, I stopped taking the codeine and I was fine."

The first is addiction, from a novel.

The second is my experience. It is also what I read and hear all the time from other people with chronic pain. We hate the drug, we hate having to take them, and we hate the feeling. (My experience of getting off without problem may be an exceptional one, the chances of some form of physical dependence was certainly possible.)

Yet some doctors are trying to take away our physician's ability to write prescriptions for these drugs in the way they feel their patients need to have them. Some doctors want to take away prescriptive autonomy from physicians trying to care for their patients in the best way, and sometimes the only way, they know, the only way they have.

The Physicians For Responsible Opioid Prescribing has asked for the following changes to the way opiates are prescribed and for what type of pain:"SPECIFIC ACTIONS REQUESTED FOR CHANGES TO OPIOID ANALGESIC LABELS:
1. Strike the term "moderate" from the indication for non-cancer pain.

3. Add a maximum duration of 90-days for continuous (daily) use for non-cancer pain.

It continues with "STATEMENTS OF SCIENTIFIC BASIS FOR PETITION":

1. Over the past decade, a four-fold increase in prescribing of opioid analgesics has been associated with a four-fold increase in opioid related overdose deaths and a six-fold increase in individuals seeking treatment for addiction to opioid analgesics.5 2. Prescribing of opioids increased over the past 15 years in response to a campaign that minimized risks of long-term use for CNCP and exaggerated benefits.3 Long-term safety and effectiveness of managing CNCP with opioids has not been established.9 4. Recent surveys of CNCP patients receiving COT have shown that many continue to experience significant chronic pain and dysfunction.5 surveys using DSM criteria found high rates of addiction in CNCP patients receiving COT.6. A large sample of medical and pharmacy claims records found that two-thirds of patients who took opioids on a daily basis for 90 days were still taking opioids five years later.7. Patients with mental health and substance abuse co-morbidities are more likely to receive COT than patients who lack these risk factors, a phenomenon referred to as adverse selection.15 8. Three large observational studies published in 2010 and 2011 found dose-related overdose risk in CNCP patients on COT.9.COT at high doses is associated with increased risk of overdose death18, emergency room visits19 and fractures in the elderly20. "
((http://www.citizen.org/documents/2048.pdf )
I cannot respond to all of it. I can to the issue of abuse and misuse, which is what they have been throwing at us (or against us) for some time now.

It is disturbing to me that the information they use is wrong.

Chronic pain patients rarely become addicted. they may become physically dependent which is a completely different animal. For instance one study found:
"The results of this evidence-based structured review indicate that COAT chronic opioid analgesic therapy) exposure will lead to abuse/addiction in a small percentage of CPPs (chronic pain patients), but a larger percentage will demonstrate ADRBs (abuse/addiction and aberrant drug-related behaviors) and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction."
(http://www.ncbi.nlm.nih.gov/pubmed/18489635 )

This is what most of us already know, a small number of people with chronic pain develop addiction and the larger number that they say abuse/use illicitly tend to have a history of abuse.

That leads (me) to the conclusion that it is not the majority of pain patients but a subset that most doctors should be already careful with because of their history of substance abuse.

They also rely on the statistics: "four-fold increase in opioid related overdose deaths and a six-fold increase in individuals seeking treatment for addiction to opioid analgesics."

Sounds scary but there is no proof or data included that makes it a 1 -1 relationship, that the increased number of people given the drug(s) are the same as the ones who are overdosing or seeking treatment for addiction. (And seeking treatment is not synonomous with being diagnosed as addicted or being treated for addiction/abuse.)

They also talk about overdose risk, that is the case with many medications, not just opiods. I am not aware (which does not mean it is not out there) of a similar petition from physicians that, say, psychiatric medications, or even aspirin or ibuprofen, be limited to 90 days and specific dosage because of the risk of overdose. All medications have an overdose risk, specifically if you give them to people that should not be receiving them in the first place.

That is part of a physician's job; to weed out those patients he sees as someone who would be at risk if given a certain drug, a specific dosage.

I find this petition appalling. Once again it is chronic pain patients who are under attack.

It seems more relegated to the fallacious War On Drugs, then a medical issue, even for these physicians behind the petition.

15 comments:

As a chronic pain patient myself, this makes my blood boil. In 5 years of taking opioids, I have never taken more than was prescribed by a physician, never felt the "high" that I hear addicts in documentaries talk about chasing, and I'm sure that *most*, true, chronic pain patients can agree. It is infuriating that the people who choose to abuse these drugs, the people who had no real reason to begin taking them in the first place, have caused every single patient who *needs* these medications to function (and function poorly by "normal" standards) to feel ashamed for taking their medicine, to feel embarrassed when questioned by unfamiliar physicians and physician assistants about their reasons for needing the medicine and the dose and length of time that they've been taking it, and to feel like an addict when they are told they are physically dependent on the only type of medication that has been able to ease their suffering. If the *true*, undeserving, addicts were not abusing these drugs, they would, and frequently do, move onto something else. Those people should have no reflection on the real chronic pain patients, but unfortunately we are being treated as if we were no better than any other drug addict. I have stayed on the same dose of medication for years, because I'm too terrified of being labeled as a "drug-seeker" to confess my true pain level to my physician. All because completely irrelevant people to my situation have painted the picture of chronic pain patients as frauds and addicts. I literally began to shake with rage as I read your post, because it's not fair that we are treated this way by our doctors, family, and friends. I will follow the link you shared to voice my disgust with whoever is supporting this madness. I wish people could live a day, just one measly day, in our shoes. Then they would be fighting for better pain control. Thank you for bringing this to our attention.

Sorry for the "wall of text" post, I have trouble typing on my cell phone and can't physically use a computer anymore. I had to vent my anger though. I felt like I was going to explode. :) Hope you're having a reasonable-pain day!

Vent all you want. It is worthy of your anger. No other disorder is treated like this, invisibility being a big part of it, and the media playing up the problems but not covering the issue of life with chronic pain.

So many people who get addicted to pain medication have addictive personalities. There are always risks, and this certain group shouldn't have to suffer. It's why I wrote "The Great Pain Jack," to educate people on chronic pain, options for pain management, and the plethora of ways pain can take over a life.

What's worse is discovering that you live in a state where the Board of Medicine regards most pain management physicians as DANGEROUS CRIMINALS, who must be eradicated, like fleas, lice and vermin. One doc I spoke with told me about a pain patient who'd just moved here from Michigan, probably thinking that jobs were more plentiful here. He'd gone down the local list of pain management physicians, calling each office, only to discover that NONE of the recommended docs were able to prescribe opiods any more, because of the State Board of Medicine's stripping those doctors licenses, for a year. The only way to get their med licenses back was to sign an agreement stating that the doctor in question WOULDN'T EVER PRESCRIBE OPIODS for the rest of their careers.The patient said that he couldn't and wouldn't live that way, decided then and there to return to Michigan, back to a place that he knew he'd get appropriate treatment.Obviously, if there are fewer and fewer physicians able to treat chronic pain patients, the few left are going to be inundated by "the patients left holding the bag."If treating us so that we can try to live an approximation of a "normal life " is considered DANGEROUS AND CRIMINAL, the resulting suicides are considered what, exactly? The price in misery, like Shakespeare's famous pound of flesh, must give the Board a vampiric satisfaction.It's irrational. If one visits the State Board of Medicine site, and investigates the selection DISCIPLINARY FAQS, the example used is....A physician who has violated the rules by prescribing too many narcotics !!!!

Interesting coincidence? You can believe that if you want to. Me, I stopped believing in coincidence.

I got a call from a hysterical patient who'd just discovered that her doctor's prescriptions were no longer being filled. She was on methadone and another analgesic for breakthrough pain. Suddenly she had NO MEDICATION.

I told her to get to an ER ASAP. She said, "What do I say?" "Tell them you're doc prescribed methadone for you, you can't get the prescriptions filled, and believe me, no one will want you to go cold turkey in front of them. "She was afraid. After all, it WAS "drug seeking behavior", so she was scared that she'd be turned away. In the end, age calmed down and went. Yes, they saw her and treated her with compassion.

I made a reply earlier, but I came back here to get the link that was shared.

I noticed your comment, and have to say, as someone who went from being treated in Michigan, to being horribly treated where I moved to (in the south), it is night and day how different the doctors are when it comes to treating chronic pain. In Michigan I was able to get sufficient enough pain control to go to a college class once a week for one hour (!). Since moving here, I've been almost 100% bed ridden from the pain. The many procedures that I was forced to go through (in order to keep seeing the pain management doctor) didnt help either.

If it keeps getting worse I'm sure everyone will find out, much too late, that the deaths of patients who had to end their own suffering due to lack of treatment were completely unnecessary. If only the medical professionals were allowed to do their jobs. Insanity.

THANK GOD I'VE FOUND SOME PEOPLE WHO AGREE WITH ME THIS IS JUST A FAIRLY RECENT WAY OF HANDLING PATIENT IN CHRONIC PAIN IN CANADA. IT NDOES MAKE MY BLOOD BOIL TOO. I WISH FOR JUST ONE DAY THE LEGISLATORS AND SOME DOCTORS FOR THAT MATTER COULD EXPERIENCE WHAT I GO THROUGH ON A DAILY BASIS SINCE BEING WEANED DOWN (LIKE I'M SOME KIND OF BABY') I WENT TO THE DOCTOR THURSDAY AND SHE GOT MAD AT ME FOR TELLING HER I'VE BEEN IN MORE PAIN SINCE THE LAST SIX MONTHS WEANING. SHE SPOKE FOR 20 MINUTES ON HOW IT WAS IMPORTANT I TRY THIS NEW DRUG LYRACA AT 25 MG TO START ...GAVE ME THE PRESCRIPTION AND WHEN I TOOK IT TO THE PHARMACY IT WAS GOING TO COST ABOUT TWO HUNDRED DOLLARS A MONTH IS ISNT COVERED BY OUR GOVERNMENT DISABILITIES PROGRAM. THERE FORE I CANT AFFORD IT ...SO I WENT TBACK TO THE DOCTOR BECAUSE I WAS UNSURE OF WHAT TO DO. SHE HAD GIVEN ME SAMPLES OF 75 MG. AND AFTER AN HOUR SAID OH JUST START ON THESE SO I LEFT I TOOK ONE THAT NIGHT ANS SLEPT GFOR 14 HOURS, AWOKE WITH A MASSIVE HEADACHE AND NAUSEA TO BOOT. FRANKLY I'M AT MY WITS END. AND NOT SURE WHAT TO DO OR SAY WITHOUT CONSEQUENCES COMING AT ME SHAME ON YOU LEGISLATORS KARMA IS REAL AND I HOPE IT COMES TO MEET EVERY ONE OF YOU. FOR ALL THOSE IN THE SAME BOAT GOD SPEED YO9U ARE FAR MORE REASONABLE AND RATIONAL THAN THESE POLITICAL GOOFBALLS. KIM IN KITCHENER ONTARIO CANADA

The first physician who diagnosed me with Fibromyalgia was herself a Fibromyalgic. For several months, during consultations, she'd speak rapidly, and throw in the term FM in the midst of the rest. At first, I had no idea what she was saying. Once the letters were burned into my brain, the next time I was with her, before she'd say her thing and gallop out of the room, I FINALLY asked her what FM meant.

She looked at me, absolutely astonished. You're a textbook case. Considering what a sophisticated medical consumer you are, I'm AMAZED that you didn't already know.Despite loosing most of a decade's memories, THAT sentence has stayed with me. MOST DOCTORS do not assume anything like that. It wasn't listed in my medical history.After that, I went to the bookstore. Lo and behold, Devin Starnyl's first book on Fibromyalgia jumped into my hands.

From then on, it was war. Eventually, ANYTIME I went to her, the first thing out of her mouth was-This better not be about how much pain you're in.She once asked me to touch her back. It felt fibrotic and stiff, to about an inch in depth. Naugahyde! Gross.-My massage therapist says my back is the worst she's ever seen.She said it proudly. Then she said that she'd NEVER missed a day of work because of having FM.One Friday, I was overwhelmed with pain. I was crying. I called the doc on call, explained my level of misery, and had to grovel and beg for half an hour, finally ending up with a prescription for....

Any doc that tells you, well I have pain/I have what youhave and I am okay with it is not a doc who understands that she is not there to listen to hersrlf(himself) speak but to listen and care for the patient.I am so sorry that these expeirneces happened/are happening to you.Thanks for posting

It is truly astounding that one human being can judge and dismiss the inner feelings of another regarding tolerance of painful sensation. Why is it that others feel that they can read the minds and bodies of those who seek only relief of constant, ongoing, unending pain and agony? If one could truly chose a malady to "fake", chronic pain would be last on most people's lists. I read somewhere that since the population is now aging, older MD's are starting to experience the true pain of arthritis-and have since decided it worthy of treatment with opiates for it's severity. Think of all the little old ladies they sent home with an aspirin and a pat on the head! What comes around goes around - one can only hope!

((*_*)) Youre right about why fake chronic pain, although because of its invisibility it is the easiest I would think but to me not worth the effort. Besides as more and more see the person doing what they say to doc they cat do the rig would be up.As for aging of docs, youre right there too for sure.